Cost coverage of abortion pill doesn’t improve rural access

The B.C. government’s recent announcement of universal, no-cost coverage for Mifegymiso – an oral alternative to surgical abortion – has been looked to as an answer for improving access to abortion in rural communities across the country.

The combination of Mifepristone and Misoprostol, currently free in five other Canadian provinces, is used to terminate early pregnancies only –up to nine weeks or 63 days from the last menstrual period.

Most B.C. pharmacies will provide Mifegymiso once it becomes fully cost-covered Jan.15, and will likely order it on an as-needed basis.

But the zero-cost price tag on the pill may remove just one of many barriers facing rural women with unwanted pregnancies.

To get a prescription, patients are required to have an ultrasound to confirm the gestation stage and ensure that an ectopic pregnancy – when a pregnancy occurs outside the uterus – isn’t taking place.

Most rural doctor clinics don’t have ultrasound equipment, so patients will need to travel to the closest hospitals or urban centres where ultrasounds are available. Even then, long wait times can cause delays and ultrasounds at private clinics often come with a fee.

Frédérique Chabot, director of health promotions for Action Canada for Sexual Health and Rights, says that since the decriminalization of abortion nearly 30 years ago, improving access in rural communities has been one of the biggest struggles.

“Access really varies across Canada and the people who are getting the short end of the stick are definitely people in rural and remote areas,” she said. “To offer a medical abortion is way more accessible for service providers than to set up the services needed for surgical abortion.

“In a rural community you don’t have the same access to a pretty important medical service. And that’s not what our health care system is about. It’s supposed to be universal.”

While Chabot said cost coverage for Mifegymiso is a huge step towards removing multi-tiered access, Action Canada for Sexual Health and Rights is still advocating to remove the current ultrasound requirement.

“Cost coverage was the first step that we had identified as making the biggest difference,” she said. “[Before] people would have to pay out of pocket – something like $400. We had a pretty major victory with most Health Canada restrictions being taken down, but the mandated ultrasound continues to stand in the way for access in some areas.

“We’re working with a lot of activists and other organizations to continue to chip away at these barriers.”